Analysis: Swine flu is not just a hoax by big pharma

As the dreaded autumn wave ends and official deaths remain relatively low, the backlash against the H1N1 pandemic response is in full swing. Claims range from a massive overreaction by health authorities to a conspiracy cooked up by big pharma. But while swine flu may have boosted profits for vaccine manufacturers, the reality of the pandemic is more complicated.

First off, the pandemic isn't over. While cases in western Europe and North America have tailed off, the virus is still spreading in eastern Europe, Africa and Asia. Meanwhile, Europe and North America could see cases rise again, if the flu pandemic of 1957-8 is anything to go by (see graph).

By January 1958, following an initially low death rate, officials assumed the pandemic was over, and vaccine went unused. But then there was a wave of deaths in the US in February, which might otherwise have been avoided. "They had vaccine but they didn't encourage its use," says Anne Schuchat of the US Centers for Disease Control and Prevention in Atlanta, Georgia. To prevent a similar scenario, the CDC recommends continued vaccination. Yet several countries and US states have vaccine gluts, and many European countries are cutting orders and selling or giving vaccine away.

Even if we don't see a 1958-style comeback, classifying the pandemic as a damp squib at this point would be premature. Although the World Health Organization's official death toll stands at 13,000 worldwide, this is likely to be an underestimate. "We anticipate that these figures will be much larger," Keiji Fukuda, head of flu at the WHO, told the press last week (PDF). Many cases are not seen by doctors, or are misdiagnosed: the CDC estimates that flu directly causes 2.7 times as many deaths as are officially counted in the US.

False perspectives

What's more, straight death counts mask what was particularly scary about 2009 H1N1: that it doesn't just strike the old and infirm. About 90 per cent of seasonal flu victims are over 65. In contrast, 88 per cent of H1N1's victims have been under 65.

The perception that H1N1 is harmless may stem from ordinary people rarely seeing the severe cases, says D. A. Henderson of the University of Pittsburgh in Pennsylvania, who ran the CDC's flu surveillance in 1957 and famously led the eradication of smallpox. Of a similar misperception in 1957, he says: "A quarter of Americans had flu, and there were excess deaths. But for one watching from close range, it did little more than disrupt school football schedules."

What about the millions paid to vaccine companies? All the scientists contacted by New Scientist say launching vaccine production at the start of the pandemic was appropriate. "When a virus emerges from the animal reservoir you don't know how it will behave," says Ilaria Capua of the World Organisation for Animal Health's flu reference lab in Legnaro, Italy. "We were quite lucky with this virus. Would you prefer to have no vaccine? This was the only thing we could do."

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Cases of swine flu are still on the increase in areas outside North America and western Europe (Image: Mohammed Abed/Getty)